From the Oregon Health and Science University, Division of Trauma, Critical Care and Acute Care Surgery, Trauma Research Institute of Oregon (D.A.H., L.J.F., L.K., J.D., S.U., D.L., J.W., M.A.S.); and Portland State University (C.W.),Portland, Oregon.
J Trauma Acute Care Surg. 2014 Jul;77(1):20-7; discussion 26-7. doi: 10.1097/TA.0000000000000268.
Liquid preserved packed red blood cell (LPRBC) transfusions are used to treat anemia and increase end-organ perfusion. Throughout their storage duration, LPRBCs undergo biochemical and structural changes collectively known as the storage lesion. These changes adversely affect perfusion and oxygen off-loading. Cryopreserved RBCs (CPRBC) can be stored for up to 10 years and potentially minimize the associated storage lesion. We hypothesized that CPRBCs maintain a superior biochemical profile compared with LPRBCs.
This was a prospective, randomized, double-blinded study. Adult trauma patients with an Injury Severity Score (ISS) greater than 4 and an anticipated 1-U to 2-U transfusion of PRBCs were eligible. Enrolled patients were randomized to receive either CPRBCs or LPRBCs. Serum proteins (haptoglobin, serum amyloid P, and C-reactive protein), proinflammatory and anti-inflammatory cytokines, d-dimer, nitric oxide, and 2,3-DPG concentrations were analyzed. Mann-Whitney U-test and Wilcoxon rank sum test were used to assess significance (p < 0.05).
Fifty-seven patients were enrolled (CPRBC, n = 22; LPRBC, n = 35). The LPRBC group's final interleukin 8, tumor necrosis factor α, and d-dimer concentrations were elevated compared with their pretransfusion values (p < 0.05). After the second transfused units, 2,3-DPG was higher in the patients receiving CPRBCs (p < 0.05); this difference persisted throughout the study. Finally, serum protein concentrations were decreased in the transfused CPRBC units compared with LPRBC (p < 0.01).
CPRBC transfusions have a superior biochemical profile: an absent inflammatory response, attenuated fibrinolytic state, and increased 2,3-DPG. A blood banking system using both storage techniques will offer the highest-quality products to critically injured patients virtually independent of periodic changes in donor availability and transfusion needs.
Therapeutic study, level II.
液体保存的浓缩红细胞（LPRBC）输注用于治疗贫血和增加终末器官灌注。在整个储存期间，LPRBC 会发生生化和结构变化，统称为储存损伤。这些变化会对灌注和氧释放产生不利影响。冷冻保存的红细胞（CPRBC）可以储存长达 10 年，并且可以潜在地最大限度地减少相关的储存损伤。我们假设 CPRBC 比 LPRBC 具有更好的生化特征。
这是一项前瞻性、随机、双盲研究。损伤严重程度评分（ISS）大于 4 分且预计需要输注 1 至 2 单位 PRBC 的成年创伤患者有资格参加。入组患者随机分为接受 CPRBC 或 LPRBC 治疗。分析血清蛋白（触珠蛋白、血清淀粉样蛋白 P 和 C 反应蛋白）、促炎和抗炎细胞因子、D-二聚体、一氧化氮和 2,3-DPG 浓度。Mann-Whitney U 检验和 Wilcoxon 秩和检验用于评估显著性（p<0.05）。
共纳入 57 例患者（CPRBC 组 n=22，LPRBC 组 n=35）。与输注前相比，LPRBC 组的白细胞介素 8、肿瘤坏死因子 α 和 D-二聚体的终末浓度升高（p<0.05）。在输注第二单位后，接受 CPRBC 输注的患者 2,3-DPG 较高（p<0.05）；这种差异在整个研究过程中持续存在。最后，与 LPRBC 相比，输注的 CPRBC 单位中的血清蛋白浓度降低（p<0.01）。
CPRBC 输注具有更好的生化特征：无炎症反应、纤维蛋白溶解状态减弱和 2,3-DPG 增加。使用两种储存技术的血库系统将为危重症患者提供最高质量的产品，几乎与供体可用性和输血需求的周期性变化无关。
治疗研究，II 级。
